Current Issues

Summary of Behavioral Health Community Programming

Pilot program for vulnerable Medi-Cal recipients to improve health outcomes and reduce utilization of high-cost services. $40M annually from 2016-2020. Core goal is to increase linkages and services outside of the health system into the larger community. Program Aims include:

Coordinate health, behavioral health, and social services in a patient-centered manner

In Partnership with Antioch PD, will implement new arrest-diversion protocols and intensive, coordinated services for people with behavioral health issues who have been repeatedly arrested for a broad array of low-level, non-violent charges. Will combine coordinated diversion with peer-driven outreach and engagement, evidence-based behavioral health services, wrap-around social and vocational support, and housing opportunities for program participants.

Passed by California voters in November 2014, Proposition 47 – also known as the Safe Neighborhoods and Schools Act – is designed to reduce incarceration across the state by reclassifying certain low-level crimes from potential felonies to misdemeanors, and to reinvest the subsequent savings into community-based drug and mental health treatment, programs for at-risk students in K-12 schools, and victim services.

Detention Health Services – Fall 2016

Chief of Detention Health Services position created, hired David Seidner, who is now certified with the National Commission on Correctional Health Care.

New Director of Quality of Care position created and hired.

Updating Jail Health Standards and separate Mental Health Standards - studying/visiting other systems (Atlanta and Sacramento) and determining best practices to implement throughout our detention system. Every aspect of detention Healthcare is under review.

Core service delivery is safety first for all. Working on a treatment approach, rather than a simple medication approach.

Adding a 2nd Psychiatrist at WCDF to increase the amount of people who can qualify to be housed there - regardless of their medications need.

On-going improvement academy for employees.

Working to integrate all systems of care within detention health - formed team workgroups to give feedback/solve problems.

Working toward limiting the amount of time any individual is held in a safety cell.

Case management to coordinate services Family Partners, with lived experience caring for family members with serious mental illness, support families of participants and help them navigate services and resources Wraparound services for children with serious emotional disturbances that involves each family's social network Therapy for depression and anxiety, self-harmful behaviors, post-traumatic stress disorder and difficulties related to traumatic life events Positive Parenting Program (Triple P) to increase parents' confidence in their parenting abilities

Family-based treatment of eating disorders

Other Services:

Psychological evaluations to aid with placement planning and treatment of children in the child welfare system who have been removed from the home due to abuse or neglect First Hope, a prevention program that provides diagnostic and treatment services for adolescents and young adults who are at risk for psychosis Full Service Partnership (FSP) for participants who may need 24-hour services, including crisis intervention and stabilization, treatment, family support, and family education services Intensive Home-Based Services (IHBS) provides intervention in the home and school for foster children and youth at risk of foster care placement Mobile Response Team (MRT) travels to participants who are 18 and younger to provide immediate crisis intervention Multi-Dimensional Family Therapy (MDFT) is family-based treatment for substance-abusing adolescents, or those with co-occurring substance use and mental disorders Multi-Systemic Therapy (MST) is community-based, family-driven treatment for antisocial or delinquent behavior in youth Therapeutic Behavioral Services (TBS) for youth who are placed or being considered for placement in a high-level group home or locked treatment facilities for treatment

Will expand benefits to treat substance use disorders, Increase and improve the quality and availability of SUD services, Expand the types of services available, Support coordination and integration of physical and behavioral healthcare systems, reduce emergency room and hospital inpatient visits, ensure faster access to SUD services while also increasing program oversight and integrity at the county and state level

Provide a clinician at each Probation Office (east, west, central). Screen each referral for services – provide short term case management or link to other more appropriate services.

Assess Public Defender Social Worker referrals and refer to appropriate care. Referrals from Napa State Hospital – assess those soon to be released and identify support in the community.

Receive 1370 Incompetent to Stand trial referrals directly from the court (misdemeanor cases only). Assess for inpatient or outpatient restoration training. If outpatient restoration is deemed appropriate, once they have completed the curriculum they are reassessed, and if appropriate, inform the court that he/she is competent to stand trial.

23 acute psychiatric beds serving persons over the age of 18 with acute behavioral health concerns. Operated on a 24-hour basis, and admission to the inpatient unit can be either on a voluntary or involuntary basis. The unit is staffed with nurses, physicians, social workers, and occupational therapists, and provides patients with structure, psychotherapy and support groups. In addition to psychiatric services, an internist visits the unit daily to address general medical concerns.

The following types of treatment are offered and incorporated into individualized plans for patient care:

Networked system of services that provides a "No Wrong Door" service mechanism to help returning citizens succeed in reintegrating into the communities where they resided before incarceration, consequently leading to a significantly reduced recidivism rate, increased public safety, and healthy family reunification.

Networked system of services that provides a "No Wrong Door" service mechanism to help returning citizens succeed in reintegrating into the communities where they resided before incarceration, consequently leading to a significantly reduced recidivism rate, increased public safety, and healthy family reunification.

“No Wrong Door” (NWD) engagement sites are a collaboration of community and faith-based organizations that provide information, referrals, engagement and support to returned citizens. Citizens are able to get access to: Mentor Services, Family and Community Reunification, Housing, Employment and Education, legal services, Women’s Services

Partnership with Center Point, Inc. to provide services for parolees living in Contra Costa County through the California Department of Corrections and Rehabilitation (CDCR)-funded STOP (Specialized Treatment for Optimized Programing) project. Services include Department of Health Care Services (DHCS) licensed residential, Sober Living Environments, Transitional Housing and DHCS certified Outpatient services to all parolees at no-cost to the County. Center Point, Inc. is the contracted provider with CDCR to serve parolees in Northern California.

Coordinated Outreach, Referral and Engagement (CORE) teams: Establish relationships with clients through regular communication and visits to camps and shelters, and serve as a point of contact to connect clients to shelter, medical and mental health care, case managers, substance use disorder treatment and services, benefit counselors, housing and other services. CORE teams are part of a larger H3 initiative to streamline homeless services in Contra Costa County, funded in part through $1.2 million in grants from the U.S. Department of Housing and Urban Development (http://cchealth.org/h3/services.php#simpleContained1)

Family Maintenance: Families whose children are at risk of neglect or abuse, and who state they are willing to accept voluntary services, may be eligible for up to 12 months of Family Maintenance services if it is determined the children can remain safely in their home while these services are being provided. Nearly 1,700 children and their families are currently receiving Family Maintenance Services. (http://ehsd.org/children/family-maintenance/)

Family Preservation: Intensive support services are provided to families with children who are at risk of out-of-home placement. This program emphasizes keeping families together in a safe, nurturing environment and providing them with skills that will stay with them when they leave the program. Staff develop intervention techniques that are tailored to fit the individual needs of families. Each year, nearly 120 families within the Children & Family Services Bureau receive intensive services that help them stay together, safe and healthy. (http://ehsd.org/children/family-preservation/)

Promoting Safe & Stable Families: Services include information and referral assistance, childcare, parenting classes, educational support groups, youth activities, and domestic violence counseling. Services are provided by collaborations of community based organizations and are free of charge. (http://ehsd.org/children/safe-and-stable-families/)

Independent Living Skills Program: provides services to youth up to age 21 who are in-care or recently emancipated from the Foster Care System. Life Skills, Money Management, Resume Development, Young Parents Workshop, Scholarships, SAT/ACT, College Application, Housing, Cooking, etc. ILSP staff also work one-on-one with youth who might not do well in a classroom setting or might need a little extra help. 30 internet capable computers to help youth with financial aid, employment searches and resumes, housing searches and college applications. (http://ehsd.org/children/independent-living-skills-program-about-us/)

In-care transitional housing is available for youth who are still in-care and over the age 16. Youth have the opportunity to live in their own apartment, with a roommate, in a supported environment. They will learn to shop for themselves, budget, daily household chores and basic cooking. Youth must get themselves to school each day and look for part-time work. They are expected to save a portion of each paycheck. They have to have 3 letters of recommendation approval from the county, ILSP and their Social Worker.

Our Transitional Housing Plus Foster Care (18-21 AB12) Youth reside in a shared apartment and split the cost of the monthly bills with their roommate. The THP +F/C program will cover the rent and the youth will receive a stipend for their monthly expenses.

Contra Costa County currently contracts with four emancipated transitional housing providers. Every program has support staff that youth must meet with weekly and house meetings that youth must attend to address issues, teaching moments and concerns. Each program has their own requirements regarding educational plans and employment.

Appian House is a six-bed transitional living program for ages 18-21 who are homeless or exiting the foster care system. Residents are provided guidance and support to complete their education and/or maintain employment that will eventually lead to permanent housing. Over the course of the 18-month program, each youth participates in the creation of a personalized Individual Development Plan (IDP) with his or her case manager. Independent living skills, such as money management, employment search, nutrition, and interpersonal life skills workshops are offered and included in each youth’s IDP. (http://ehsd.org/children/independent-living-skills-program-about-us/county-homeless-program/appian-house/)

Bissell Cottages operates with the philosophy that every young person has the ability to make good choices for themselves, when provided with gentle guidance, support, and positive opportunities. We value the diversity, determination, resiliency, and strength that all youth

bring to our doors. 24-month transitional living program for homeless youth ages 18-24, including those exiting foster care, who need mental health services and support as they transition into adulthood. Residents receive guidance and support from a personal coordination team that prepares each youth in their movement towards greater self-sufficiency. 24-hour on site staffing. Participants receive intensive daily personal mental health service coordination. Residents also receive a full range of individual and group life skills training, counseling, substance abuse prevention groups, school enrollment and employment assistance, social-recreational activities, health care services, and a variety of peer support and education activities. Participants who complete the program will be transitioned into permanent housing. (http://ehsd.org/children/independent-living-skills-program-about-us/county-homeless-program/bissell-cottages/)

Education & Training (http://www.wdbccc.com/economic-development/education-training) Employment Services (http://www.wdbccc.com/job-seekers/employment-services) Community Corrections Partnership (AB109) Collaboration w/CAO, Sheriff's, Probation, and other public agencies and community based non-profit partners to ensure re-entry participants are able to access services and leverage resources. Utilizes the America’s Job Center of California - EASTBAY Works network, Future Build program which provide access to employment and education assessment services that focus on self-sufficiency and job-readiness for the reentry population, and other CBO’s.
Education: adult education, community colleges, Cal State, East Bay, Contra Costa Regional Occupation Programs

Industrial Safety in Contra Costa County

Contra Costa County is home to active oil refineries, chemical plants, and numerous heavy and light industrial businesses. Based on safety concerns after some serious incidents, the Board of Supervisors adopted a landmark Industrial Safety Ordinance (ISO) in January 1999, requiring regulated facilities in the County to implement safety programs aimed to prevent chemical accidents that could impact the surrounding communities. The requirements of the Industrial Safety Ordinance are some of the most stringent in the United States, if not the world. The City of Richmond passed an identical ordinance in 2000.

The purpose of the Industrial Safety Ordinance is to prevent the accidental release of hazardous chemicals; improve accident prevention through participation from industry and the community; require industry to submit a Safety Plan; and conduct audits of the plans and inspections of the industrial plants.

Contra Costa Hazardous Materials Programs (CCHMP), a division of the County Health Department, administers the ordinance. A regular performance review and evaluation report is submitted to the Board of Supervisors. The 2017 Industrial Safety Ordinance Annual Report was presented by the March 7th Board of Supervisors meeting. It can be found on the County's website at www.cchealth.org/hazmat/.

There are six businesses covered by the County’s Industrial Safety Ordinance and two covered by the City of Richmond’s ordinance. The six industrial sites covered by the County’s ordinance are Phillips 66 Rodeo Refinery, Shell Oil Martinez Refinery, Air Products at Shell, Tesoro Golden Eagle Refinery east of Martinez, Air Products at Tesoro and Air Liquide-Rodeo Hydrogen Plant. The two industrial sites covered by the City of Richmond’s ordinance are Chevron Richmond Refinery and Chemtrade West Richmond Works.

Audits of the regulated businesses are required at least once every three years to ensure that the facilities have the required programs in place and are implementing the programs. Five County ISO and two Richmond ISO audits were completed this reporting period:

There are three other programs in place to reduce the potential of an accidental release from a regulated stationary source that could impact the surrounding community. The programs are: the Process Safety Management Program administered by Cal/OSHA, the Federal Accidental Release Prevention Program administered by the U.S. EPA, and the California Accidental Release Prevention Program administered locally by CCHMP. The Industrial Safety Ordinance is also administered by CCHMP. Each of the programs is very similar in requirements, with the Industrial Safety Ordinance being the most stringent.

The Board of Supervisors approved an amendment to the Industrial Safety Ordinance in June 2014, broadening the goals and requirements of the regulation following the 2012 Chevron Refinery fire investigation report.

The ISO requires the regulated stationary sources to do an incident investigation with a root cause analysis for each of the major chemical accidents or releases that meets the definition of a Level 3 or Level 2 incident in the Community Warning System incident level classification system, based on meeting one or more of the following criteria:

• Results in one or more fatalities
• Results in greater than 24 hours of hospital treatment of three or more persons
• Causes property damage (including cleanup and restoration activities) initially estimated at $500,000 or more.
• Results in a vapor cloud of flammables and/or combustibles that is more than 5,000 pounds

Over a 17-year period, there has been a trend towards fewer and less severe Major Chemical Accidents or Releases incidents in the County since the adoption of the Ordinance. There were several Community Warning System Level II and Level III incidents in 2012 that caused some concern. There was one Major Chemical Accident or Release for the County Industrial Safety Ordinance facilities in 2015 and one Major Chemical Accident or Release at a non-ISO facility in 2015. These incidents serve as a reminder of the need to stay vigilant in ensuring safe facility operations. There were no major incidents in Contra Costa County in 2016.

Staff continues to work with other agencies such as the EPA, Cal/OHSA, the U.S. Chemical Safety and Hazard Investigation Board, and the Bay Area Quality Management District, along with other local program agencies, for sharing of incident results, regulatory interpretations, and inspection results to improve effectiveness and prevention.

Contra Costa County’s System for Helping the Homeless

Contra Costa County provides the "safety net" for those in need in our community. The Contra Costa Homeless Continuum of Care (CoC) is currently designing and implementing a Coordinated Entry System (CES) to ensure that homeless individuals, and those at-risk of homelessness, receive the most appropriate services to meet their housing needs.

The Coordinated Entry System is a collaboration of multiple community, government, and faith-based agencies that collectively provide services ranging from prevention to permanent housing placements. Homeless individuals are linked to the support needed to obtain and sustain housing. They move into the system by calling 211, going to one of our Coordinated Assessment and Resource (CARE) Centers, or through our Coordinated Outreach Referral and Engagement (CORE) teams.

The 211 information line, operated by the Contra Costa Crisis Center, provides a phone portal for individuals and families needing to connect to homeless services. Callers will be connected to CORE Team and CARE Centers. 211 is in the process of implementing Prevention and Diversion Screening and Referral services, and in September will begin a centralized reservation system for direct placement into emergency shelters.

Our CORE outreach teams have begun to engage and stabilize homeless individuals living outside and are helping to facilitate and deliver health and basic needs services, and locate permanent housing. Evening CORE teams can provide direct placement into shelter beds.

CARE Centers located in Richmond, Concord, and Walnut Creek provide a walk-in option for individuals and families who need to connect to homeless services. Services offered at CARE centers include help with basic needs, light case management, housing navigation services, and substance abuse treatment and support.

The Concord CARE Center also serves as an after hours Warming Center to offer much needed support in a safe environment overnight. CORE teams and law enforcement will be able to make warming center placements.

CORE teams establish relationships with clients through regular communication and visits to camps and shelters, and serve as a point of contact for many social services. A 2016 count showed that about 1,100 county residents are without shelter on any given night.

Most Contra Costa cities rely on their police departments to manage homelessness, leading to a drain on public safety resources as officers repeatedly respond to complaints about public disturbances, theft and panhandling; often involving the same few people. Those booked for infractions such as public intoxication or urinating in public rarely remain in jail longer than a night. They are often released a few hours after booking at Martinez Detention Facility.

To help alleviate the impact on their police, Martinez and Pleasant Hill will soon share a full-time outreach team to connect with homeless residents as part of a new Contra Costa Health Services (CCHS) plan to more efficiently deliver services to the county’s homeless community. The cities agreed to fund the cost of a two-member team of CCHS outreach workers who will operate 40 hours a week within their boundaries.

There is no one single solution to eradicating homelessness in our community. Through these programs the County has implemented in cooperation with our cities and many non-profit groups, I am hopeful that we can make a difference in the lives of individuals living on the street. For more information about Homeless Services in Contra Costa County and how you can help, go to cchealth.org/homeless.

Alternatives to Toxic Pesticides

Growing up in Hawaii it was common for me to encounter a wide range of insects and pests both inside and outside my home. Weeds grew quickly in the warm tropical environment. Our response? My family had a monthly contract with a pesticide company to spray both the inside and outside of our house with a thick layer of toxic chemicals. Fortunately, these pests and fast growing weeds aren’t as prevalent here in California, but how I manage them now is very different from my childhood in Honolulu. There are some great alternatives available to using highly toxic pesticides.

It is important for us to do our part to preserve our environment for future generations. We also want to keep our children, pets, and wildlife safe from harmful chemicals. Since 2001, Contra Costa County governmental departments have reduced their pesticide use by 60%. However, the County’s use of pesticides is only 2% of all reported use in Contra Costa.

Before using pesticides or rodenticides around your home or business, consider other options. There are great resources available to help you make an informed decision about how to handle any number of pest problems, whether it is insects, rodents, or weeds. Some that I have found very helpful include the following.

The Our Water-Our World program is a partnership between many different water pollution prevention agencies and stores that sell pesticides to the public. Their goal is to help you manage home and garden pests in a way that protects the health and safety of your family, pets, and the environment. Visit their website at www.ourwaterourworld.org to find materials designed to assist you in finding non-toxic and less-toxic solutions for managing pests in and around your home, including helpful fact sheets, and their booklet, Pests Bugging You? Choose Products Less Toxic to People, Pets and the Environment! Click on “promotional materials” and then on “booklets.”

The University of California Statewide Integrated Pest Management Program has numerous fact sheets on managing pests in and around the home with a minimum amount of pesticide. You can find the fact sheets at www.ipm.ucdavis.edu/index.html.

The Statewide Integrated Pest Management Program also has a variety of links to inform you of the types of pesticides on the market with their risks to the environment and your family. They offer non-toxic methods, disposal suggestions and more. Visit their site at www.ipm.ucdavis.edu/GENERAL/pesticides_urban.html.

Trained volunteers from the Contra Costa Master Gardener Program answer questions from Contra Costa County residents about pests and pesticides during their Help Desk hours, Monday through Friday from 9am to Noon. You can visit them at 75 Santa Barbara Road, 2nd Floor, Pleasant Hill, CA 94523; call them at 925-646-6586; or send an email to ccmg@ucanr.edu. Visit their website at www.ccmg.ucanr.edu/ for more information about gardening in Contra Costa.

The Contra Costa Agriculture Department can also answer questions about pests and pesticides. They have a biologist on-call from 8am to 5pm at their Concord office, 2366-A Stanwell Circle. You can bring your pest problems into the office or call 925-646-5250 for advice.

The Mt. Diablo Audubon Society has information on their website regarding a variety of issues that affect our wildlife such as DON'T TAKE THE BAIT! AntiCoagulant Rat Poisons Kill, which you can read on their site at www.diabloaudubon.org/conservation.php#RatPoison. There is also a link to their brochure called Who Will Save Us?, which you can print and distribute to others, also on their site at www.diabloaudubon.org/WhoWillSaveUs-E.pdf.

Finally, if you have any of these toxic products on hand, please dispose of them safely by taking the materials to your hazardous waste facility. In Contra Costa County, call 1-800-750-4096 for locations and information or go to www.co.contra-costa.ca.us/depart/cd/recycle/.

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Response to the service has been overwhelmingly positive, from both citizens who have used it and from staff who have expressed how rewarding it is to be able to help residents navigate the sometimes complicated maze of County government information. Much of the information is actually available on various pages of the County website. Your inquiries through LiveChat, which are tracked and reported to the County’s departments, will help to organize the information so that it will be easier for future visitors to find.

My staff works hard to make my own District 2 website informative and up to date with many useful resources for my constituents. In addition to links to all of the District 2 city websites, you will find links to many local, county, and state organizations such as East Bay Regional Park District, Contra Costa Water District, local CERT training groups, and the California Secretary of State for voter registration. You will be able to see the advisory boards I make appointments to, where there are vacancies, and learn how to apply for those openings. You can also quickly access the Board of Supervisors’ agendas for the current and past meetings, view past issues of my e-Newsletter, as well as sign up to receive a copy each month via email. If you’re not already, I encourage you to become one of our many regular e-Newsletter subscribers. Each month’s edition showcases local events and includes short, informative articles about what is going on in the County. Join my mailing list by clicking on e-Newsletters in the left navigation list. Along with my Facebook page and Twitter account (@AndersenCandace), my e-Newsletter is another way of communicating with you on a regular basis.